Outcome of remission induction in childhood acute lymphoblastic leukemia treated with modified BFM-90 protocol and UKALL 2011 interim guidelines, Single Centre experience from Pakistan


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Safia Khan1,Muhammad Latif2,Mazin Sirelkhatim3,Faisal Azam2
1The Children's Hospital & ICH, Lahore,2king Fahad Specialist Hospital,3North Wales Cancer Treatment Centre



Various induction therapy regimens are used to achieve remission in acute lymphoblastic leukemia (ALL) in children. Aim of this study is to compare the outcome of remission induction in patients treated according to modified Berlin, Frankfurt, Munster 90 (mBFM-90) protocol and United Kingdom ALL 2011 (UKALL -2011) interim guidelines.


This descriptive cohort study was conducted at the Children’s hospital Lahore, Pakistan from September 2014 to August 2015. Clinical information sheets of patients with diagnosis of ALL were retrospectively reviewed. Data regarding demographics, risk categorization, rapid early response (RER) assessment and end of remission induction assessment was collected separately for patients treated with mBFM-90 protocol and UKALL -2011 interim guidelines. Data was analyzed using IBM SPSS software.


A total of 98 patients with ALL were identified with median age of 6.4 (1.5-16) years. Forty eight (49%) patients received induction therapy as per mBFM-90 protocol and 50 (51%) patients were treated according to UKALL 2011 interim guidelines. In mBFM-90 group, 29% (n=14) patients were standard risk and 71% were high risk (n=34). Majority of patients (n=30, 60%) were standard risk in UKALL 2011 group followed by high risk (n=20, 40%). RER was noted in 18 (37.5%) patients in mBFM-90 group and 11(28%) patients in UKALL 2011 group. Remission was achieved in 38 (79%) patients in mBFM-90 cohort and 36 (72%) patients in UKALL 2011 group. RER was significantly associated with remission (p=0.003) in overall study population. Statistically significant association of RER with remission was observed in UKALL 2011 group (p=0.005) but not in mBFM-90 group.


End of induction remission rate was comparable in two treatment groups. RER was found to be significantly associated with remission in overall study population. In UKALL 2011 group, statistically significant association between RER and remission was observed. There was no association between risk group and remission.